Is it OK to K tape…?

I am curious yet skeptical about most things in this profession, especially the things that are said to add to our ‘tool box‘, the so called ‘adjuncts‘ to treatment. However, in my experience, these often end up being nothing more than a waste of time, energy, and money, and more importantly they usually end up being found to be clinically ineffective.  

One of the most common adjuncts I now see being used widely and liberally is this stretchy multi coloured Kinesio Tape or K Tape. A lot has been discussed, researched, debated and argued about K Tape, and I have had my fair share of these debates over the years. It has its staunch advocates, and its staunch critics, and it seems you can’t go a week without a new paper being published, showing how it fixes stuff, or how it doesn’t. However, after some more recent heated discussions on it, I thought it was time I added my two penneth and ask, is OK to K Tape?

What is K Tape?

Just in case you have been living under a rock for the last few years, I thought I have a recap of what K Tape is. K Tape in a nutshell it’s brightly coloured, sticky, stretchy, elasticated tape, thats designed to be worn for long periods. There are many different brands out there, and they all argue the toss other about whose is the best. They all seem to claim that their brand is better than any others due to its elasticity, stickiness or range of neon colours. They also all try and out do each other with sporty or sciency sounds names, terms and marketing, its all a little bit silly!

Anyway, regardless of the brand, colour, name etc, all K Tape has a wave or strip like adhesive backing that is the crux of its perceived uniqueness. This wave adhesive is believed to produce a lifting effect on the skin creating channels of less pressure underneath it, and is thought to help improve blood and lymphatic flow under the skin, as well as reduce pressure on nerves, muscles, tendons and ligaments, and mechanically stimulate skins mechanoreceptors. 

This is claimed to improve sporting performance and prowess, helping muscles to recover and function better, stronger and for longer (this is even a brand of K tapes marketing logo). It also has been claimed to reduce swelling, bruising and pain after injury.

Is there any evidence?

Strong claims demand strong evidence, and to put it as succinctly as I can, and for the sake of brevity, there just isn’t ANY robust evidence to support ANY of these claims.

Now I am sure many will disagree (see the comments section soon) and they will start to throw research paper after research paper at me, telling me how wrong I am, and how this type of tape, applied this way, reduces this pain, or improves this condition, in this population, with this condition, etc, etc.

However, before you do start to post these papers in the comments section, the inconvenient truth for any K Tape believer, or even denier, is that for every paper that shows a positive effect, there is one that shows little or no effect. For every poorly designed, biased study claiming significant results, there is another showing none. Simply put, as with most things in the world of adjunct research, its all a bit of a mess, with no ‘clear’ answers either way. Even systematic reviews and meta analysis on K Tape cannot come to any firm conclusions, some for, some against. The phrase, more research is needed, seems to apply more than usual.

But does it?

Ok, so new methods and treatments do need time to establish an evidence base and demonstrate effect sizes. K Tape has had plenty of time to demonstrate this.

It was first conceived by Dr Kase in Japan over 40 years ago, but, to be fair it has only been widely used in the west since the Beijing Olympics back in 2008. But that’s still plenty of time to build some evidence base and demonstrate its effect.

They haven’t.

And if they haven’t by now, they are in my opinion unlikely to in the future. If the effect of K tape was that strong we simply should have seen it by now, there simply should be ‘more’ conclusive, robust evidence. Not the confusing quagmire that currently exists. However I am sure that many K Tape advocates will continue to search for the pony for many more years to come.

So is it OK to K tape?

Simply put… NO

Ok, before you all go bat shit mental in the comments section AGAIN let me explain a little more why I don’t think its OK to K Tape by sharing with you my own personal experience with it. I first came across K Tape in 2009 when working in football. A sales rep came to our club for a few hours, wowed us all with stories of the Bejing Olympics and athletes performing better, stronger, longer (there’s that logo again), he got the the brightly coloured rolls out, proceeded to demonstrate the applications on us and, BOOM, we where hooked, we ordered 100 rolls right there and then. I guess we were all a little more gullible back then, or rather just fucking idiots!

Anyway I did want to learn more about this K Tape stuff, so I went on an ‘official’ course. Now I won’t mention any brand names for obvious reasons, but I was amazed, although in hindsight not really that surprised, at the complete lack of research or evidence to back the bold claims that were, and still are, being made about K Tape.

However, I still thought it’s new, it needs time and there seems to be little harm or risk involved. So I gave it the benefit of doubt, and I started to use it over the next couple of years, both in professional sport and on the general public. I even tried it on my own aches and pains, and was even asked to do a couple talks on it, giving my own special, skeptical and cynical opinions.

And I did find that patients and athletes liked this stuff, in fact everyone fucking loved it. Feedback was nearly always positive, with many saying they ‘felt’ it helped reduce pain or ‘felt’ it helped increase movement. However, as time went on, and the more I used it, the more I became to realise that the effects from K Tape were also extremely unreliable and extremely unpredictable. The only thing I could consistently say about K Tape was the effects were ALWAYS temporary, ALWAYS small, and more importantly K Tape was ALWAYS without fail a big huge fucking distraction.

So much so it became annoying for me to constantly have players and patients all giddy and amazed about this gawdy coloured sticky stuff I had just put on them, and it tended to distract them from focusing or paying any further attention to anything else I had to say, or ask them to do, which was always the more important stuff.

I also began to notice that some were becoming dependent on this bloody tape, just coming back to see me to have the tape re-applied, and not that concerned or attentive to any other parts of their rehab. Thats when I realised its NOT ok to K tape

So I don’t use it anymore

Not only have I stopped using K Tape, I have over the last few years stop using most other adjuncts completely, and have decluttered my metaphorical ‘tool box’. Actually I can say I have emptied it completely! My ‘adjunct’ list is now pretty much zilch, nada, nothing! No tape, no needles, no machines, no creams, no lotions, no clicks, no pops, no pokes!

I even dislike the term ‘tool box’ and ‘adjunct’ as they continue to promote the idea that patients are objects that need, and can be, fixed by therapists. Read this by Jason Silvernail who also says the same.

You are not a true therapist!

Many often tell me that I am not a true Physio beacuse I don’t use tape, manipulate, massage or needle anything, and that I am not offering my patients all that is available. I think the exact opposite.

I feel more of a physio now than I ever used to. Free from the crap, bullshit and bollocks. Free from the clutter and confusion of ‘adjuncts’ and ‘tools’. Free to focus my time and attention on exploring movement and promoting activity and exercise. Free to offer my patients the one thing that matters the most… simple, straight forward, honest, advice and guidance.

It is liberating, it’s simple, it’s effective and it is enjoyable, it is everything physiotherapy should be!

Try it!

 

49 thoughts on “Is it OK to K tape…?

  1. Hi Adam,

    Nice read, especially since it does support my beliefs on our adjucts or whatever you want to call them. I feel that Adjuncts are extremely useful when it comes to patient “buy in”. However I do apply them with care and try to prevent complete reliance on them long term. Our main goal as PT’s is to get clients painfree and active, if a bit of stretchy tape gets them over that hump, perfect. I’ll burst their bubble the week after and then its all exercise from there on it πŸ™‚ Finding myself more often then not removing braces, orthotics, tape etc… and clients are very suprised at how much 2 simple exercises can do (take less than 2 minutes) vs. applying a tape that takes them about 15 minutes to put on.

  2. I think each to tier their own. There are many treatment tools and techniques I was taught during uni and while working which I can best put ‘I never quite mastered’ but that doesn’t mean I should tell all physios that it doesn’t work. It just isn’t a tool I myself can’t use. I love leukotape k it works like a bomb with the right patient , at the right time, with the right technique as with most physio tools. Don’t hack it coz you can’t get it right.

    • I assume then aamena you believe that there is some skill involved in applying kinesio tape and that I haven’t got it!

      There isn’t any skill involved in the application of tape, stick it on how you like, what does matter is as you have said is choosing the right patient at the right time, if they think or are made to think that tape works, then tape works!
      No skill in application skill is in the interaction!

      • With all due respect… No skill in application is needed? So in your opinion, it really does not matter how you apply a K Tape? Have you ever worked with an acute suppination trauma and lymph taping for example? It does matter a lot, in fact, what tension you use, where you start from and where you end! Just because you did not have the desired results, does not mean it does not work for others!
        To say, taping does not require any skill would be the same as saying manual therapy does not take any skill, it’s just pushing a little!

        • You haven’t read much of my other stuff have you? This is from a year ago stating exactly that, there is NO SKILL in manual therapy, it IS just pushing things a little here and there https://thesportsphysio.wordpress.com/2014/06/16/there-is-no-skill-in-manual-therapy-2/

          The notion in technical skill is over rated in Physio from manual therapy, exercise prescription to bloody taping things, it doesn’t really matter (mostly) how you do things, its about how you interact and engage with the patient that requires far more skill, not the other stuff!

          • Hi Adam,
            I would like your thoughts on this study – http://www.ncbi.nlm.nih.gov/pubmed/3343953
            Gwendolyn Jull is an amazing clinician and the accuracy on correctly identifying ‘symptomatic’ joints via palpation while not misdiagnosing in ‘asymptomatic’ joints is remarkable and I don’t think that chance could possibly explain this. I do however agree that most clinicians do not possess this level of skill. Perhaps skill does matter but far too many clinicians do not demonstrate it as evidenced by some research.

            • Hi Bob

              I’m sorry to say and with no disrespect but Mrs Julls ability to detect a stiff facet is no better than anyone else’s, I’m sure she and others may think differently but the evidence shows using palpation is just so inaccurate and lacks any specificity or sensitivity, in all areas!

              This is a good paper to counter the one you posted http://www.ncbi.nlm.nih.gov/m/pubmed/20185669/?i=4&from=/3343953/related and this is a blog I did on palpation over a year ago https://thesportsphysio.wordpress.com/2014/05/05/diagnostic-palpation-is-it-a-skill-an-art-or-an-illusion/

              So I will say there is no skill involved in palpation as well! Sorry

              • Thanks Adam,
                Assessing PPTs as in the paper you mentioned is not the same as assessing PPIVMs which are not generally looking for a pain response. Reduction in PPTs is generally widespread particularly when an element of central hyper excitability exists http://www.ncbi.nlm.nih.gov/pubmed/22947552 so while it does help to identify pain processes at play it doesn’t really help to identify specific peripheral drivers if they exist.

                Not only were the results of the original paper by Bogduk and Jull highly sensitive and specific, they were further supported by a study to determine the inter-tester reliability of highly skilled practitioners in this area. http://www.ncbi.nlm.nih.gov/pubmed/11676679. Again, I do not suggest that this reflects what is commonly demonstrated by many practitioners but it does provide support for the fact that potential peripheral sensory drivers can be identified OR rejected reliably by skilled practitioners. Clearly, they do not account for the entire pain experience but as sensory information from the periphery is commonly required and modulation of which (via many formats including exercise) can alter the pain experience, being able to reliably assess this is advantageous and is perhaps what we should all be aspiring to.

                Facet joint block (modifying the peripheral sensory input) reduced pain reduction of 50% or greater in a WAD group (58 responders, 32 non responders) but measures of general physical signs including PPTs was not predictive of responders (although changes in cold pain endurance, area and peak pain has been shown in non-recovery of WAD compared to those who recover) and psychosocial measures were also similar except for higher medication intake and catastrophisation in non-responders. Physical measures did however distinguish the WAD subjects from asymptomatics. http://www.biomedcentral.com/1471-2474/14/313. Further studies have shown that modifying peripheral input reduces both the physical and psychological scores but they return when the effect of the intervention (radio frequency neurotomy) wears off. http://www.sciencedirect.com/science/article/pii/S1934148215001641.

                So even in conditions with complex pain processing with accepted high levels of central hyper excitability and psychosocial influences, changing sensory input modifies these factors and in the cervicogenic headache population at least and with highly skilled clinicians accurate identification of some of these peripheral sources is possible through palpation and manual examination (but not just pushing on joints to find some sore spots).

                • This is an interesting and common view on the perceived skill of palpation which I come across often, and disagree with often

                  There is plenty of evidence showing palpation is unreliable and not diagnostic, heck I wrote a whole blog on it!

                  The therapists determined to prove that there is a skill in palpation techniques are usually those with vested interests in doing so, eg books, manual and course sales.

                  Again don’t take this as me saying poking things doesn’t do anything or help, its just doesnt really matter too much how or where you do it.

  3. Thanks Adam,
    I have read your blog on palpation previously and took the time to re-read it. I do agree with some of the points made especially with relation to some of the work done on TPs and SIJ. I disagree with some however such that those tests that are able to be reliably conducted are dependent upon pain e.g. Lachman’s. In fact, pain and swelling can make Lachman’s testing less reliable. Lack of a solid end feel is a critical finding and can be reliably detected.

    There are also problems with the research or with conclusions drawn from some research as is the example that you used on PPTs to say that manual palpation of the cervical spine is not reliable. The study shows that pressure pain thresholds are reduced bilaterally in the entire region when someone has zygapophyseal joint pain and that this threshold is lower than asymptomatics. In Whiplash you can also throw in that Tibialis Anterior thresholds are also lower suggestive of central hyper-excitability. This is already well known and it does not suggest that manual palpation cannot detect the responsible zygapophyseal joints (as determined by selective blocks). The studies that I mentioned previously did show a remarkably sensitive way of detecting this joint using PPIVMs which are looking at motion of the segments and reactivity as opposed to a pain response. PPTs may be reached before motion is even created using a pressure algometer and PPTs may be elicited from other tissue such as the muscle etc. so are also not specific to the joints and therefore cannot provide any conclusions about those joints. It is looking at something completely different to assessment of PPIVM. It just tells us a bit about the pain mechanisms in play.

    Your assumption that experience or time (25000 patients etc.) equates to skill can also be debated. On the first day of my post graduate studies half of the class was asked to lie on the bed while the other half performed a grade IV PA mobilisation on L5. They were then asked to rotate around to the next bed and do the same thing. And once again. As one of the ‘patients’ I can tell you that the location, amplitude, pain (false positive through poor handling) was very different despite this being a group of ‘experienced’ clinicians. This is consistent with the results of some of the research for sure. However by the end of that year of practising from 6am to 11pm every day, there was high consistency in these palpation skills as well as in determining symptomatic levels. There are several studies which show this also, some better than others of course. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419570/ or http://www.ncbi.nlm.nih.gov/pubmed/16837235 or http://www.ncbi.nlm.nih.gov/pubmed/10903585. These all look at palpation in isolation which is not how it is used in practice. I believe future studies are looking at palpation combined with a sound clinical reasoning process.

    I think in many cases the research which is held up to be an absolute truth is just as subject to flaws as is the subject matter which they are testing. Most researchers have a preconceived idea and test to support rather than negate (on both sides of any question), they often make assumptions or draw conclusions that are not accurate or others draw these conclusions and promote them as fact, they may administer the technique incorrectly or inadvertently bias it through their own behaviour (and subsequent effect on the subject’s beliefs, expectations etc.), the cohort lacks uniformity so they are trying to do the same technique on a varied group and expect a consistent result, they may be third or fourth year students who just want to please their supervisor and the list goes on. When systematic reviews only come up with two reliable studies then the review is also not reliable or lacks any power.

    I agree that the mechanisms by which manual therapy may work are many and varied and not necessarily what people have thought in the past but that is a different discussion.

    By the way, I don’t teach any palpation courses or have any books.

  4. I put K tape on someone’s anterior 5th rib once. Not only did I fix their knee pain, they got improved symmetry when using a reformer! I also won the bonus ball that weekend so it must work!

  5. I use it because when it’s on the skin, it acts as a constant reminder of being touched by a therapist. Your treatment can continue as long as the tape stays sticking to the skin.

  6. Hello,

    Fantastic article! I would be more than pleased if you could share your opinion about foam rolling ? I can’t find reliable articles which could put some shade on that topic. I am from Poland and almost everyone is foam rolling here, cause again they want to ‘release’ their muscles. Not sure if this method sometimes doesn’t cause more damage to tissues than actually help.

    Thanks in advance !

  7. If you are looking at the fashion now and how everything is going to pain mechanisms and psychosocial framework you will realize that for example pain mechanism papers are at the level of experts opinion(the first step in order to build qualitative studies), The whole mechanism is not fully understood. So, what are we doing with our clinical reasoning there?
    High quality studies proved that KT is not efficient, dry needling is not recommended by latest guidelines and so on, everything can be debatable

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